93295 CPT® code: payer coverage and prior authorization2 of 5 payer prior-auth lists that name 93295 require prior authorization or set conditions: Molina Healthcare of Ohio.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth under conditions | no PA under 18 | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Ohio | Exchange | OH | prior auth under conditions | no PA under 18 | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
93295 appears in 4 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Body Surface Potential Mapping (0705) | listed, no stance | Nov 24, 2025 | payer document |
| Aetna | Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors (0548) | covered if criteria are met | Aug 21, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 92920-93799) | Jul 23, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Implantable Cardioverter Defibrillators (SUR707.003) CPT Codes 0571T, 0572T, 0573T, 0574T, 0575T, 0576T, 0577T, 0578T, 0579T, 0580T, | listed, no stance | Dec 15, 2025 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.